BAPTISM INTEREST

Baptism Candidates Info

6022 Candlewood St. Lakewood, California 90713
Today's Date

Month Day Year
Date
Name

First Name Last Name
Life Center Church Voting Member?

Yes No
Address

Street Address

Apt, Suite, Etc

City State / Province

Postal / Zip Code
Your Email *
Birthdate:
Please give Month, Day, Year for our Baptism Registry
Place of Birth:
Please give City & State for our Baptism Registry
Home/Mobile #

Area Code Phone Number
Please check all that apply: *

I would like to signup for the next Baptism Class I want to get baptized I am a Christ follower
Date of Baptism

Month Day Year
Date
Take Photo
OR Upload a photo
Upload a brief video story of how you became a believer in Jesus
Please make sure your video is shot in landscape not in portrait.
Please tell how you came to Christ and a part of your spiritual journey – what does Jesus mean to you? (one paragraph)
Please fill out if unable to upload your Video Story
Comments or Questions
Please sign here, approving your information and video to be shared with the Life Center family and posted on our private social media forums *

You can use your FINGER or MOUSE Clear
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Baptism Candidates Info